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. 2015 Mar;16(2):58-66.
doi: 10.1177/1757177414556007. Epub 2014 Oct 27.

Infection control intervention on meticillin resistant Staphylococcus aureus transmission in residential care homes for the elderly

Vivien Wm Chuang  1 , Iris Hl Tsang  1 , Jessica Py Keung  1 , June Yy Leung  1 , Janet Mt Yuk  1 , Doris Kw Wong  1 , Sui-Sum Au  1 , Rebekah Ky Tam  1 , Wendy Wy Lam  1 , Martin Ct Kwan  1 , Andrew Ty Wong  1
Affiliations

Infection control intervention on meticillin resistant Staphylococcus aureus transmission in residential care homes for the elderly

Vivien Wm Chuang et al. J Infect Prev. 2015 Mar.

Abstract

Background: The objectives were to evaluate the effectiveness of an infection control bundle in controlling the meticillin resistant Staphylococcus aureus (MRSA) transmission in residential care homes for the elderly (RCHEs) in Hong Kong.

Methods: This was a two-arm cluster randomised controlled trial. Infection control bundles focused on hand hygiene (HH), environmental hygiene, and modified contact precautions were applied to the intervention arm. Nasal swabs from residents; staff HH compliance and effectiveness; and environmental hygiene were assessed by microbiological sampling or observation at the baseline and quarterly after the intervention.

Results: A total of 2776 residents from 36 RCHEs were recruited. The overall MRSA prevalence was 20.4% (95% confidence interval, 18.9%-21.9%). The intervention elicited an immediate effect of 2.4% absolute decrease in the prevalence and 3.7% in the intra-facility transmission, though the difference between the two arms was insignificant. Staff HH compliance increased substantially from 5.9% to 45.6% post-intervention (p < 0.001).

Conclusions: We initiated the infection control culture into the RCHEs and gained their acceptance. However, this behavioural change takes time to emerge. Our study shows that relying on the bundle alone could not bring sustainable MRSA reduction. Administrative control for strengthening infection control infrastructure is important for continuous compliance and improvement.

Keywords: Care home; cluster randomised controlled trial; elderly; environmental hygiene; hand hygiene; infection control; long-term care; meticillin resistant Staphylococcus aureus; nursing home.

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Conflict of interest statement

Declaration of conflicting interest: None declared.

Figures

Figure 1.
Figure 1.
Flow diagram of the participants through the phases.
Figure 2.
Figure 2.
Meticillin-resistant Staphylococcus aureus (MRSA) prevalence and intra-facility transmission rate of the intervention arm and the usual care arm across different phases.
Figure 3.
Figure 3.
Hand hygiene compliance rate of staff in residential care homes for the elderly (RCHEs).
See this image and copyright information in PMC

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